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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THA � 1 .1 INFORMATI N
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURDS,SIDEWALKS . DRIVEWAYS, MAROUEES'ETC) WILL REQUIRE
GRADMGIFILL
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PERMIT APPLICATION; ISO DAYS
PERMIT LIMJT�. I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
STORM DRAINAGE FEES
PPLICA ON BE" ALF OF HIS OR HER SPOUSE. HEIRS. ASLIGNS AND SUCCE;ORS
ENG, INSPECTION FEE
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ALLCI_AOS5X0AR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT, ISSUA CE OF THIS PERMIT SHALL NOT BE
DEPOSIT
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PLAN CHECK
NORLIMITI N ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
TO LA 5 5.,
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
THE 01
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR DULY AUTHORIZED AGENT
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL ThIl IPPI1111- �l "I A P011it 11VI 11910d bY IF'
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION 01 THE LABOR CODE 01 THE STATE 01 WASHINGTON RELATING TO
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FOR INSPECTION P, ,&,�dvd �� P� dod,
WORKMEN S COMPENSATION INSURANCE AND FEW 18.27.
__TGNATPRE (OW DATE SIGNED
F NER OR AGENT�
(425) 0111C, D IF
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771-0220,
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ATTENTION
IT IS UNLAWFULT6 USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE - YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK, OWNER - COLD ASSESSOR